Provider Demographics
NPI:1366623175
Name:JOHN S. OUSLEY, DDS, MSD, PA
Entity Type:Organization
Organization Name:JOHN S. OUSLEY, DDS, MSD, PA
Other - Org Name:JON S. OUSLEY DDS, MSD, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:OUSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:972-296-1835
Mailing Address - Street 1:7005 PASTOR BAILEY
Mailing Address - Street 2:SUITE 100 A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2649
Mailing Address - Country:US
Mailing Address - Phone:972-296-1835
Mailing Address - Fax:972-296-1867
Practice Address - Street 1:7005 PASTOR BAILEY
Practice Address - Street 2:SUITE 100 A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2649
Practice Address - Country:US
Practice Address - Phone:972-296-1835
Practice Address - Fax:972-296-1867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX09077840Medicaid
TX009848501Medicaid